Print this pagePPO Rates
You pay $57.50 each month.
- The premium listed is for both medical services and prescription drug benefits.
- There is no calendar-year deductible for services received in-network
- Except for the following services, you pay a calendar-year deductible of $500 for most services received out-of-network
- Annual physical exams
- Ambulance services
- Emergency care
- Hospice
- Hearing aid and eyewear allowances
- Outpatient drugs
- Routine hearing and eye exams
Extra Help
Availability of Medicare Subsidy Information
You may be able to receive extra help for your prescription drug premiums and costs. If you qualify for extra help, your premium and drug costs will be lower than what is published. When you join Medicare Blue PPO, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay.
To see if you qualify for extra help, call:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. For the hearing or speech impaired, please call 1-877-486-2048.
- The Social Security Administration at 1-800-772-1213, 7 a.m. - 7 p.m. CST, Monday - Friday. For the hearing or speech impaired, please call 1-800-325-0778.
- Your State Medicaid Office.
The premiums listed are for both medical services and prescription drug benefits.
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